Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is a distressing and often debilitating psychological illness that affect up to 2% of the general population and one in every two hundred children.

If you or someone you know is suffering from OCD, help is available. Our program specializes in evidence-based treatment for children and adults with OCD. At this time we offer both medication management and cognitive behavioral therapy (CBT).

What is OCD?

OCD is a mental illness characterized by recurrent, unwanted, anxiety-provoking thoughts, images, or impulses followed by repetitive behaviors aimed at reducing anxiety. Common intrusive thoughts, or “obsessions,” include a fear of germs or dirt, fear of harming someone unintentionally, a concern with order, symmetry or exactness, religious obsession, preoocupation with numbers, or unwanted sexual thoughts. Obsessions are unwanted thoughts that do not go away and are disturbing to the person experiencing them. The thoughts occur with such frequency and intensity that they can interfere with everyday activities such as school, work, dating, and social life.

“Compulsions” are repetitive behaviors intended to reduce the anxiety caused by the obsessions. Common compulsions are washing, checking, reassurance seeking, praying, counting, and avoidance of things that trigger obsessions. Compulsions often temporarily reduce anxiety but are not a long-term solution. Compulsions can occupy a lot of time and interfere with important activities.

OCD sufferers can spend hours per day having obsessions, performing compulsions, or even avoiding situations that could conceivably trigger their OCD. OCD is not an occasional worry about getting sick or sticking to a consistent routine. OCD is very distressing and can make day to day life miserable. OCD typically begins between the ages of 10 and 12 or in late adolescence/early adulthood. It is a brain disorder that runs in families and affects serotonergic and glutamateric systems in the brain. It most often requires treatment.

What is PANDAS?

Increasing research suggests that some children develop OCD following an immunological infection such as Streptococcus. This rare condition, known as P.A.N.D.A.S. (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus) is a subset of more conventional pediatric OCD. However, unlike most children affected by OCD, those with P.A.N.D.A.S. experience a very rapid onset of the disease (often times over just a few days or weeks). Children experiencing P.A.N.D.A.S. experience new anxieties, sensory or motor abnormalities, hyperactivity, and urinary difficulties in some instances.

While the rapid-onset nature of P.A.N.D.A.S. can be quite scary and debilitating for both children and their families, the Pediatric OCD team at Massachusetts General Hospital is very experienced and knowledgeable in the treatment of this rare condition.

For more information on PANDAS, please contact Paula Downes at 617-724-0198.

What treatments are available?

Our program specializes in evidence-based treatment for children and adults with OCD. At this time we offer both medication management and cognitive behavioral therapy (CBT). For more information, please contact our intake coordinator, Barbara Davidson, at 617-726-6766.

What is CBT?

Cognitive-Behavioral Therapy, or CBT, for OCD generally focuses on exposure and response prevention (ERP). During the course of CBT, a therapist assists the individual in identifying anxiety provoking thoughts and situations and developing a step-by-step plan for treatment. With the assistance of an experienced clinician, individuals with OCD gradually expose themselves to increasingly anxiety provoking situations and learn strategies to cope with the anxiety without performing unwanted time-consuming rituals. Exposures are done at a pace that the individual is comfortable with and no one is ever forced to do anything that they are not willing to do. Over time, by confronting their fears, individuals experience less anxiety, less frequent obsessions and a marked reduction in compulsive behavior. Moreover, the therapy is designed to provide the individual with skills that he or she can use long after the therapy has ended. CBT is a very well-studied treatment for OCD that has helped thousands of patients.

Serotonin Reuptake Inhibitors are the most commonly prescribed medications for OCD. Typically, SRI dosages used to treat OCD are 3-4 times higher than the dose required to effectively treat depression symptoms. SRIs that are FDA approved for the treatment of OCD include: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), and Clomipramine (Anafranil). Additionally, Paroxetine (Paxil CR), Citalopram (Celexa), and Escitalopram (Lexapro) are commonly prescribed off-label for the management of OCD symptoms and all of the aforementioned drugs have performed well in clinical trials for the management of OCD symptoms.

In addition to the commonly prescribed SRIs, Serotonin-Norepinepherine Reuptake Inhibitors (SNRIs) such as Duloxetine (Cymbalta) and Venlafaxine (Effexor) have been efficacious for the treatment of OCD in some patients.

An important aspect to keep in mind about medication for the management of OCD symptoms is to make sure you give them an honest trial with the assistance of your prescribing physician. SRIs can take between 10 and 12 weeks to start working and need to be ingested at regular intervals, not just when you’re feeling anxious.

Often times a combined CBT and medication regime is the preferred treatment for Obsessive-Compulsive Disorder. Our clinic is one of the oldest and longest running OCD treatment centers in the world and has always been committed to advancing the treatments for OCD with its pioneering research efforts. For more information on our research study options, click here.